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IGIV Gamunex C Insurance Question

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Old 10-07-2017, 12:16 PM   #1
dhackle
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Default IGIV Gamunex C Insurance Question

Please share your experiences. What is best way to get it paid thru insurance? I have Medicare and a Medicare supplement policy. Also Medicare Part D Drug Plan. I cannot get a definitive answer from my Doctor's staff or Medicare. Feeling very frustrated.
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Old 10-08-2017, 12:14 PM   #2
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It is harder and harder to get Gamunex these days, especially through insurance. I got it for about 16 years and got completely cut off of it a year ago. My neuro tried everything, including several appeals, to no avail.

Medicare can cover it, but only if it's given in an out-patient setting. That would probably be the most successful way to pursue it. You will have to be persistent, as insurers in general are not that helpful. Keep calling your doc and Medicare every day! The squeaky wheel gets the grease!

Good luck!
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Old 10-10-2017, 10:55 PM   #3
dhackle
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Default Anybody else care to share?

122 views, just one response. Do I need to post elsewhere?
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Old 10-11-2017, 10:51 AM   #4
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dhackle, I believe quality is far more important than quantity! You received one of the best responses, from someone who has been through a lot with MG. More views than responses is typical of every forum.

There are past posts here regarding this topic as well. You can do a search of this forum to find them.

I don't have personal experience with Gamunex, so I can't tell you more. I do know that a lot of paperwork is involved in having IVIG. Since a few years ago, they are defining IVIG as used on a regular basis only for some conditions (MG is not one of them). IVIG is used when a patient is having an exacerbation or nearing a crisis (at least that is how the insurance companies define the use). Some people are lucky enough to have IVIG on a regular basis.

Call your insurance company and see what they need to have it covered. Then speak to your neurologist and let them know what is needed. Cover all your bases and hope for the best. That's the reality we are in now.

I hope you can have the treatment covered!

Annie
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Old 10-11-2017, 11:17 AM   #5
dhackle
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Quote:
Originally Posted by AnnieB3 View Post
dhackle, I believe quality is far more important than quantity! You received one of the best responses, from someone who has been through a lot with MG. More views than responses is typical of every forum.

There are past posts here regarding this topic as well. You can do a search of this forum to find them.

I don't have personal experience with Gamunex, so I can't tell you more. I do know that a lot of paperwork is involved in having IVIG. Since a few years ago, they are defining IVIG as used on a regular basis only for some conditions (MG is not one of them). IVIG is used when a patient is having an exacerbation or nearing a crisis (at least that is how the insurance companies define the use). Some people are lucky enough to have IVIG on a regular basis.

Call your insurance company and see what they need to have it covered. Then speak to your neurologist and let them know what is needed. Cover all your bases and hope for the best. That's the reality we are in now.

I hope you can have the treatment covered!

Annie
Annie..thank you. Very good info. Doing so now. Waiting to hear.
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Old 10-11-2017, 11:30 AM   #6
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122 views, just one response. Do I need to post elsewhere?
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Old 10-11-2017, 11:48 AM   #7
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I have been doing IVIG for about 12 years and am on Medicare and a supplemental policy. I do it through an out-patient infusion center at my local hospital. I recommend you contact the infusion center you are thinking of using and ask what their experience has been with getting Medicare to approve IVIG. They have the most experience with filing the claims and know the steps that are most likely to get you approved. If they can't help you, you might ask to speak to the billing department and see if you can get your answers there. My past experience has been that it has a lot to do with the diagnosis code that is filed with the claim.

Good luck and I hope you get approved.
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Old 10-11-2017, 01:25 PM   #8
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Originally Posted by Juanitad View Post
I have been doing IVIG for about 12 years and am on Medicare and a supplemental policy. I do it through an out-patient infusion center at my local hospital. I recommend you contact the infusion center you are thinking of using and ask what their experience has been with getting Medicare to approve IVIG. They have the most experience with filing the claims and know the steps that are most likely to get you approved. If they can't help you, you might ask to speak to the billing department and see if you can get your answers there. My past experience has been that it has a lot to do with the diagnosis code that is filed with the claim.

Good luck and I hope you get approved.
I have actually done that, waiting for the elusive call back. Billing department...had not thought of that. Great idea! Thank you!
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Old 10-12-2017, 08:14 AM   #9
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I was on regular IVIG treatment for about a year. I had my treatments at an outpatient treatment center. There was not a problem with Medicare paying its portion, but there was still a substantial copay. In my case, I qualified for financial help for the copayments through my local hospital. That might be another avenue to explore if you will be receiving ongoing treatments. It can get very expensive over time, even if you are able to get insurance coverage for the main part of the bill.

Take care,
Erin
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